Research report
Cor pulmonale secondary to tonsillar and adenoidal hypertrophy: management considerations

https://doi.org/10.1016/S0165-5876(98)90037-4Get rights and content

Abstract

Eleven cases of cor pulmonale secondary to tonsil and adenoid hypertrophy and upper airway obstruction were reviewed. These patients presented with a spectrum disease ranging from mild, with only abnormal ECG or chest X-ray findings, to severe with hypercarbia, hypoxia, and right heart failure. One patient with severe disease suffered a postoperative respiratory arrest. We have successfully managed 4 patients with severe cor pulmonale with postoperative intubation and assisted ventilation. Hypoxia is the driving stimulus for respiration in patients with upper airway obstruction and hypercarbia. Relief of respiratory obstruction by tonsillectomy and adenoidectomy with postoperative oxygen administration may remove the hypoxic drive, resulting in respiratory arrest. Patients undergoing tonsillectomy and adenoidectomy for upper airway obstruction disease should be screened for cor pulmonale. Affected patients should be managed after surgery in an intensive care unit (ICU) environment with careful monitoring of the respiratory status. Patients with severe cor pulmonale can be successfully managed with planned postoperative intubation and mechanical ventilation to prevent respiratory arrest.

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    Citation Excerpt :

    Although cor pulmonale is more likely to occur in children with concomitant chronic lung disease, it has been found to occur in children with OSA alone.63 Several studies have shown that the alleviation of upper airway obstruction by adenoidectomy and/or tonsillectomy is also successful in reversing this condition.95–99 Sofer et al. performed M-mode and 2D echocardiography in four children (aged 1 and 3.5 y) who presented with cor pulmonale, pulmonary oedaema and severe respiratory distress due to chronic upper airway obstruction.99

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Presented before the Society of Ear, Nose and Throat Advances in Children, Denver, CO, December 1987.

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